Provider Demographics
NPI:1740724954
Name:BUFORD, LORIE (RABAT-16-21942)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:BUFORD
Suffix:
Gender:F
Credentials:RABAT-16-21942
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 N RIDGE BLVD APT 2224
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-4102
Mailing Address - Country:US
Mailing Address - Phone:352-247-0460
Mailing Address - Fax:
Practice Address - Street 1:1290 N RIDGE BLVD APT 2224
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-4102
Practice Address - Country:US
Practice Address - Phone:352-247-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-21942106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician